COMMUNITY HEALTH

ROXANNE RIEDY MSN

MARILEE ELIAS MSN, CNE

Community

• “the gift or fellowship of common relations and feelings”(Hiemstra, 2000)

• It’s a group:–of like-minded people– that works together –who share a common language, rituals,

and customs

Population

• All the individuals inhabiting a specific area

• Leesburg, FL 22,286 (2009)

• Clermont, FL 13,252 (2009)

(www.census.gov )

Aggregate

• A group of individuals with at least one shared characteristic (personal or environmental)

• We each belong many aggregates. What are some of yours?

Community Components

• Structure • Status • Process

Community Components

Structure: general characteristics of a community, includes:

– Demographic data

– Data about healthcare services

Community ComponentsStatus: describes the outcome components

of the community

– Biological Outcome Components

– Emotional Outcome Components

– Social Outcome Components

Community Components• Process: the overall effectiveness of

the community

– Perceptions of group membership

– Extent of intergroup interactions

– Community forum for conflict resolution

What makes a Community Healthy?

Healthy People Initiatives

• We’re in the 4th decade of this national health framework for public health preventions priorities and actions.

• The overarching goals and focus topic areas are refocused every 10 years using the input from public health and prevention experts, government officials and the public.

Healthy People 2020• “The launch of Healthy People comes at a

critical time. Our challenge and opportunity is to avoid preventable diseases from occurring in the first place.” HHS Secretary Katherine Sebelius

• Use of IT to make Healthy People come alive through a “challenge” to develop ‘myHealthyPeople’ apps. (www.healthypeople.gov ) 

• Revision of Healthy People 2010

Healthy People 2020• 13 New Topic Areas• Main (or broad) goals of this plan:

– increase healthy life expectancy– reduce health care disparities– create social and physical environments that

promote good health for all – Promote quality of life, healthy development,

and healthy behaviors across all life stages

New Topic Areas 2020

• Adolescent Health Genomics• Blood Disorders & Blood Safety Global Health• Early and Middle Childhood Preparedness• Dementias, including Alzheimer’s Disease• Healthcare-Associated Infections• Health-Related Quality of Life and Well-Being• Lesbian, Gay, Bisexual, and Transgender Health• Sleep Health• Social Determinants of Health

What’s in Healthy People 2020?(www.healthypeople.gov)

Each Community also has Vulnerable

Populations

• Aggregate with increase risks for:

– Developing illness

– Adverse health outcomes

Vulnerable Populations

Vulnerability Factors:– Limited economic resources– Limited social resources– Age– Chronic disease– History of abuse or trauma

Federal Poverty Levels

• Issued each January– Range of 25% to 300% of Poverty Level– Based on Family Size– Pregnant woman= family of 2

• Low-income assistance programs base benefits on these official income levels

Community Nursing

• A Community is:

–A site for Healthcare Delivery

–A recipient of Healthcare Services

Community Based Care

• Focuses on the community • Focuses on lowering the cost of care • Healthcare Services are provided in

many types of Facilities• Acute care• Rehabilitative services

Community Based Care

Three approaches

• Community health nursing• Public health nursing • Community oriented nursing

Community Based Care

Community Health Nurse • Focus: how the Individual’s Health

affects the health of the community• Goal: maintain health of the

population• Deliver personal health services

Community Based CarePublic Health Nursing

• Focus: effect of Community’s Health on individual

• Goal: prevention of disease; promote health

• Protect health of the community• Large-scale programs

Community Based Care

Community-Oriented Nursing• Combines community and public

health• More comprehensive approach• Uses information from individuals to

change health on the community level

Pioneers of Community Nursing

• Florence Nightingale• Lillian Wald• Clara Barton• Margaret Sanger

Community Nursing

• Empowering the Individual and the Community:– Access and Use Available Resources– Achieve/Maintain Desired Level of Health– Achieve Autonomy– Maintain Positive Self-esteem

Roles of Community Health Nurse

• Client advocate• Educator• Collaborator• Counselor• Case Manager

Community Nursing Intervention Classification

• Primary (first-level)• Secondary (second-level) • Tertiary (third-level)

Community Based Careers

• School nurse• Occupational health• Parish nursing• Correctional nursing• Public health• Disaster services• International

Geopolitical Community Assessment

• Windshield survey• Databases• Client perceptions

Nursing Diagnosis

• Analyze the information, develop a list of the communities strengths and limitations

• Prioritize the information• Create a community based diagnosis

Nursing in Home Care

Home Health• Established in 1800’s• Growth R/T Medicare Payments (1965)• Over 132,000 RNs delivering care• Over 1,000,000 Work in Home Care• Over 12 million patients • 2009 projected costs over $72 billion

( www.nahc.org, 2012)

Home Health Care Recipients

• Individuals with skilled-care needs• Recuperating from illness or surgery• Terminal ill• On going care for individuals with

chronic illnesses in an attempt to prevent hospitalization

How do our clients get referred to home

healthcare?

• Hospital-based Referrals• Other Community Sources of Referrals• Reimbursement Evaluation

Goal of Home Health care

• Promoting self-care by:

– Fostering client independence– Completing client/family teaching– Demonstrating skill techniques– Explaining all aspects of care

Home Health Care

• Advantages• Disadvantages

Home Health Agencies

• Direct care agencies• Indirect service agencies• Types of agencies

Public

Voluntary

Proprietary

Hospital-based

Home Health Team

• RN is coordinator of health services• Multidisciplinary Team based on

patients needs

Roles of Home Health Nurse

• Direct care provider• Client /family educator• Client advocate• Care Coordinator

Hospice Nurse

• Focus is caring for pt’s who are dying or condition is not expected to improve

• Care can be provided in the hospital, home, nursing home or Hospice house

• Promote comfort & quality of life

Reimbursement

• Medicare• Medicaid• Private insurance company• Patient Self-Pay

Medicare• Individuals over 65 or• Disabled or• Diagnosis of ESRD• Largest payer- over $15 billion (2007)• Employer- over 90,000 RNs• Criteria-based Reimbursements

Medicaid

• Individuals with limited financial resources

• Sponsored by federal government and each state

• Payer for Home and Hospice Care

Private Insurance

• Sources:– Employer– Retirement Plan Benefit– AARP and other available plans

• Criteria-based Reimbursements (again)

• Documentation is Vital for Payment

Future of Home Health Care

• Expect Increased Use• Increased home Hospice care• Technological advances = safe and

affordable complex care in the home• Expanded research

Home Visit

Three phases• Preparation prior to the visit• Nursing care provided during the visit• Evaluation after the visit is completed

Home Visit

Before the visit:– Review Chart/Referral Form– Gather necessary Supplies/Materials– Assess need for additional information– Schedule Home Appointment– Assess Safety Issues

Home VisitDuring the visit:

– Make introductions– Initial Visit is vital to building trust/rapport– Be respectful of client’s home, beliefs,

practices, cultural differences– Develop a trusting relationship– Verify/complete data– Identify barriers to goals– Begin Documentation

The Home Visit Review• We’re Nurses so we:

– Assess• Client• Home Safety Issues• Infection Control Issues

– Generate Nursing Diagnoses• Risk for Caregiver Role Strain• Caregiver Role Strain

– Plan Outcomes/Evaluations– Plan Interventions/Implementation

Home Visit

After the visit:– Safety (again)– Proceed to safe area PRN & then– Complete necessary documentation